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General NPI Number Information
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NPI Number | 1578953766
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Entity Type | Organization
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Legal Business Name | MARINA DENTAL PLLC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 01/27/2015
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Provider Practice Location Address
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Address Line | 5406 AIRLINE DR SUITE F
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City | HOUSTON
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State | TX
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Zip | 77076-4948
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Country | US
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Telephone | 281-905-6660
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Fax |
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Provider Business Mailing Address
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Address Line | 900 S WAYSIDE DR SUITE 100
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City | HOUSTON
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State | TX
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Zip | 77023-3427
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Country | US
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Telephone | 281-974-3996
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | MRS. LAUREN EPP
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Credential |
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Telephone | 832-203-7968
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State | TX
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